Health services utilization, out‐of‐pocket expenditure, and underinsurance among insured non‐elderly cancer survivors in the United States, 2011–2015

Abstract

Background High out‐of‐pocket (OOP) expenditure and inadequate insurance coverage may adversely affect cancer survivors. We aimed to characterize the extent and correlates of healthcare utilization, OOP expenditures, and underinsurance among insured cancer survivors. Methods We used 2011–2015 Medical Expenditure Panel Survey data to identify a nationally representative sample of insured non‐elderly adult (age 18–64 years) cancer survivors. We used negative binomial, two‐part (logistic and Generalized Linear Model with log link and gamma distribution), and logistic regression models to quantify healthcare utilization, OOP expenditures, and underinsurance, respectively, and identified sociodemographic correlates for each outcome. Results We identified 2738 insured non‐elderly cancer survivors. Adjusted average utilization of ambulatory, non‐ambulatory, prescription medication, and dental services was 14.4, 0.51, 24.9, and 1.4 events per person per year, respectively. Higher ambulatory and dental services utilization were observed in older adults, females, non‐Hispanic Whites, survivors with a college degree and high income, compared to their counterparts. Nearly all (97.7%) survivors had some OOP expenditures, with a mean adjusted OOP expenditure of $1552 per person per year. Adjusted mean OOP expenditures for ambulatory, non‐ambulatory, prescription medication, dental, and other health services were $653, $161, $428, $194, and $83, respectively. Sociodemographic variations in service‐specific OOP expenditures were generally consistent with respective utilization patterns. Overall, 8.8% of the survivors were underinsured. Conclusion Many insured non‐elderly cancer survivors allocate a substantial portion of their OOP expenditure for healthcare‐related services and experience financial vulnerability, resulting in nearly 8.8% of the survivors being underinsured. Utilization of healthcare services varies across sociodemographic groups.

Adult Cancer-Related Emergency Department Utilization: An Analysis of Trends and Outcomes From Emergency Departments in Maryland and New York

“…5,11 These findings highlight that patients with cancer are not exempt from the well-documented disparities in health outcomes which adversely affect socioeconomically vulnerable populations. [33][34][35] These differences could be attributed to limited access to oncologists, regional variations in population, hospital, and insurance-specific characteristics and policies across states. We note that some of our findings on disparities differ from previous work, highlighting the need for additional studies to clarify whether these disparities persist across states and years.…”

Emergency department utilization and disposition outcomes by pediatric patients with cancer in Maryland and New York from 2013 to 2017

“…Limited financial resources might predispose late-stage presentations, as the family strives to avoid care, which will likely contribute to higher death rates. 11,28 In addition, lack of health insurance coverage was also associated with lower rates of admissions through the ED compared to Medicaid coverage among patients with cancer, without observing any large differences in admissions between Medicaid and private plans' enrollees. Previous studies on various chronic conditions and populations, including pediatric patients with cancer, have documented that uninsured patients were more likely to be discharged from EDs and less likely to get admitted to a hospital following an ED visit compared to those with public or private health insurance coverage.…”

“…These disparities could be related to financial insolvency during cancer treatment and the increased out‐of‐pocket expenses that caregivers of pediatric patients with cancer with constrained resources or without health insurance coverage face. Limited financial resources might predispose late‐stage presentations, as the family strives to avoid care, which will likely contribute to higher death rates 11,28 …”